Is My Child a Candidate for Ear Tubes?

Many children suffer from ear infections, often between six months and two years of age. Lifestyle factors may lead to more frequent ear infections in some cases, like attending group daycare or secondhand smoke exposure. Children with chronic or recurrent ear infections, or those for whom hearing loss or speech delay are suspected due to fluid behind the ear drum, may be candidates for ear tube surgery.

“If your child has had three or more ear infections in the last six months, or four or more infections in the last year, with the most recent one being in the past six months, they may be a candidate for ear tube surgery,” says Dr. Kevin Huoh, a pediatric otolaryngologist at CHOC. Consult your pediatrician and ask about a referral to a pediatric ear, nose and throat specialist.

candidate for ear tubes
Dr. Kevin Huoh, a pediatric otolaryngologist at CHOC, discusses who may be a candidate for ear tubes.

“Children who have experienced hearing loss as the result of chronic fluid behind the ear drum will benefit from improved hearing as a result of ear tube surgery,” says Huoh. “For children with speech delay or at-risk for speech, language, or learning disorders, we may recommend ear tube placement at an even earlier time.”

Along with improved hearing, parents and caregivers may notice increased development of speech and language abilities. For children with frequent ear infections, ear tubes will decrease the incidence of these infections.

Ear tubes are tiny cylinders about 1 millimeter long, about the size of a grain of rice. They are surgically inserted into the eardrum to create a ventilation system for the middle ear, and also to prevent fluid from accumulating behind the ear drum, says Huoh. Audiograms, non-invasive hearing tests, are performed before and after the operation.

“After ear tube surgery, we often see patients experience an improved quality of life, including improved sleep and decreased fussiness, improved balance and improved school performance,” says Huoh.

Recovery from the routine procedure is usually very easy, he adds. Children are usually back to their normal selves within a day. Biannual checkups help care teams monitor the status of the ear tubes.

Typically, ear tubes remain in place for six-12 months before falling out on their own. If they come out prematurely, the ears will be observed for return of infections, or fluid that may require replacement.

CHOC Children’s perform this common procedure hundreds of time per year, says Huoh.

Learn more about otolaryngology services at CHOC.

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Kids and Ear Infections

An ear infection is an acute inflammation of the middle ear caused by fluid and bacteria behind the eardrum. “Usually it starts with a cold, so the child will have a runny nose and a cough. Colds can lead to  ear infections in susceptible children,” says Dr. Nguyen Pham, an ear, nose and throat specialist at CHOC  Children’s. “Older kids will pull on their ears and tell you their ears hurt. For infants, symptoms can include  fever, irritability, or changes in their eating and sleeping patterns. A pediatrician can look at the eardrum  to diagnose an ear infection.” Generally, ear infections are treated with oral antibiotics.

“The best thing families can do is to have really good hand hygiene,” says Dr. Pham. “Everyone should wash hands constantly. Encourage children to not touch their faces with their hands or rub their eyes,” he says. Colds and the flu can frequently lead to ear infections, so children should be protected against colds and get a flu vaccine, Dr. Pham advises.

“An acute ear infection can lead to temporary hearing loss because of the fluid behind the eardrum. That type of hearing loss will get better over several weeks. If it doesn’t get better, that’s the time to go to the pediatrician or a specialist,” says Dr. Pham. If you suspect your child has hearing loss, ask for an audiogram,  which is a formal hearing test. A pediatrician can perform this test or refer the child to a specialist such as  an audiologist or otolaryngologist.

Children who have four or more ear infections per year meet the criteria to have ear tubes inserted into the  eardrum. Ear tubes create a drainage pathway for bacteria behind the eardrum to get out, so infections don’t  form. This is a commonly performed surgery in the U.S. and is very effective in preventing ear infections.


  • Number of babies born in the U.S. with permanent hearing loss: 3 in 1,000
  • Percentage of children in the U.S. with some hearing loss: 10%
  • Percentage of children who will have at least one ear infection by their second birthday: 90%

View the full feature on Kids and Ear Infections

Dr. Nguyen Pham
Dr. Nguyen Pham
CHOC Ear, Nose and Throat Specialist


Dr. Pham specializes in pediatric otolaryngology – head and neck surgery. Dr. Pham completed his residency at the  UC Davis Medical Center and a fellowship at Stanford University. He practiced advanced surgical techniques in airway reconstruction, otological surgery and the treatment of congenital defects at Stanford’s Lucille Packard Children’s Hospital. Dr. Pham has participated in many humanitarian endeavors, including a medical mission to perform cleft lip and palate surgeries in the Philippines and helping patients in New Orleans after Hurricane Katrina. Dr. Pham speaks fluent Vietnamese.

Dr. Pham’s philosophy of care: “My philosophy is to truly listen to my patients and to provide compassionate  care based on the best possible scientific evidence.”

UC Irvine School of Medicine


More about Dr. Pham

This article was featured in the Orange County Register on February 24, 2014, and was written by Amy Bentley.

What Parents Can Do to Prevent Ear Infections

February is ear, nose and throat health month, and any parent whose child has had an ear infection knows how important this is.  Ear infections are common in babies and children, but they can be prevented by focusing on cold and flu prevention and family hygiene, a CHOC Children’s physician says.

Frequent hand-washing by all family members helps cut down on the spreading of germs, and it’s also important to discourage children from rubbing their hands on their faces or in their eyes, says Dr. Nguyen Pham, an ear, nose and throat speciali20130425_2730st.

“Try to do whatever you can to keep your child from getting a cold or the flu because they lead to ear infections,” says Dr. Pham. “It’s rare a child will get an ear infection without having a cold.”

If a family member has a bad cold or cough, limit contact between the sick person and others at home. Keep children away from people who are sick to the extent possible. If a child has a bad cold, keep him or her home from school or daycare so the other children won’t be exposed.

Also, parents should ensure their child gets the influenza, or flu, vaccine every year, Dr. Pham advises.

“You can also get the pneumococcal conjugate vaccine,” he says. “This vaccine can lead to a reduction in frequent ear infections in some children. Parents can ask their pediatrician about this option.”

According to the Centers for Disease Control and Prevention, studies have shown that vaccinated children get far fewer ear infections than children who aren’t vaccinated.

Other things parents can do to prevent ear infections include avoiding exposing babies and young children to cigarette smoke (studies have shown that babies who are around smokers have more ear infections), and never putting a baby down for a nap or for the night with a bottle.

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